14 September 2008

How can you spend much more on general practice and end up providing a very much worse out-of-hours service? Only this government could have done it.

Dr Grumble once spoke to a senior personage at the Department of Health. Let's call him Bill McCarthy. Bill told Dr Grumble that ministers are really puzzled as to why Dr G is so dissatisfied with their management of the NHS. After all much more money has been put in. Very much more. The trouble is, of course, that they have blown it. The government holds the NHS in trust for future generations. They have abused that trust. They have destroyed the best feature of primary care. GPs used to be responsible for their patients day and night. They did a good job. It was extremely arduous. They worked day and night. Now managers are responsible. They do not do a good job. They do not work day and night. This is how GPs used to organise cover when they wanted a rest. This is the way managers want it to happen now. The system used to rely on good will. An awful lot of good will. Sadly, now there is no good will.

That, Bill McCarthy, is just one example of why ministers should be ashamed of what they have done. They have taken advice from the wrong people and done the wrong thing. The PM's reading of Dr Grumble is admirable but he does not seem to take any notice. And, frankly, it is too late.

4 comments:

The problem is, my dear Grumble, that they do not listen to the professionals any more. They do not get out to grass roots and actually see what is going on.

They are surrounded by a coterie of advisers and 'experts' who tell them what they want to hear.

They ignore inconvenient statistics. They have alienated the senior working doctors like you and me with their incessant incompetent reorganisations, and they have massively alienated the juniors by the (Carol) Black hole that is MMC/MTAS.

I have written to my practice MP (who is a junior minister) 5 times now and not even received an acknowledgement

You are right in your first query. How can they have spent so much and achieved so little? A special kind of (Black) Magic.

A grim and lamentable account of how things have shifted, such that "consultation" by HMG in no sense meaningfully involves views of those at the coal face.

There are islands of hope. Our MP (for the hospital's neighbourhood) has met with me on a couple of occasions and genuinely has been helpful. In contrast, meetings this Summer with great and the good from the DoH was disheartening.

I'm filled with dismay that junior and more senior ministers seem to have that "coal face" attitude of representing peoples' views, but very senior ministers then have their own/their party views and seem to feel that "tough decisions being made" is a mandate for autocratic direction.

Government formed the view that there was something very wrong with the NHS at a time when there was something very wrong. The thing that was most wrong was wholly inadequate funding. They then pumped money in too late but too quickly and spent it on grandiose projects which have shown no signs of coming to fruition. They failed to realise that underfunding rather than need for reform was the main problem. To get consultants and GPs off the golf course they bizarrely decided to 'tighten up' our open-ended professional contracts so that we now get paid more for doing less. This idea came from people who clearly had no concept of what the average consultant and GP did. They would have been better off asking medical students rather than the idiotic policy wonks who clearly had no idea. Many of these changes are essentially irreversible. It has been more cock up than conspiracy.